Method and apparatus of acoustic communication for implantable medical device

ABSTRACT

An implantable medical device includes an acoustic transducer for intra-body communication with another medical device via an acoustic couple. The acoustic transducer includes one or more piezoelectric transducers. In one embodiment, an implantable medical device housing contains a cardiac rhythm management (CRM) device and an acoustic communication circuit. The acoustic transducer is electrically connected to the acoustic communication circuit to function as an acoustic coupler and physically fastened to a wall of the implantable housing, directly or via a supporting structure.

TECHNICAL FIELD

This document relates generally to implantable medical systems and particularly, but not by way of limitation, to an implantable medical device including an acoustic transducer for communications with another device by acoustic coupling.

BACKGROUND

Medical devices are implanted in human bodies for monitoring physiological conditions, diagnosing diseases, treating diseases, or restoring functions of organs or tissues. As one type of such implantable medical devices, an implantable CRM device monitors a patient's cardiac functions and/or treats cardiac arrhythmias, heart failure, and other cardiac disorders by delivering electrical and/or other therapies to the patient's cardiovascular system including the heart. One example of implantable CRM devices is implantable pacemakers. An implantable pacemaker delivers electrical pulses to the heart to restore cardiac rhythm and coordinate contractions in various cardiac regions, thereby improving hemodynamic performance. Another example of implantable CRM devices is implantable cardioverter/defibrillators (ICDs). ICDs deliver higher energy electrical stimuli to the heart to treat tachyarrhythmias including tachycardia and fibrillation. In addition to pacemakers and ICDs, examples of implantable CRM devices include, but are not limited to, implantable pacemaker/defibrillators that combine the functions of implantable pacemakers and ICDs, implantable drug delivery devices, and any other implantable devices for monitoring, diagnosing, and/or treating cardiac disorders.

Because an implantable CRM device is often intended for long-term use after being implanted in a patient, its size, complexity, and power consumption are inherently constrained. Consequently, a CRM system may include an external device or system and one or more implantable devices. The external device or system provides for a user interface for the CRM system and enables the CRM system to perform functions that the implantable CRM device alone is incapable of performing. Communication between an implantable CRM device and the external device or system is performed by telemetry through an inductive couple or a radio-frequency electromagnetic link. The CRM system may also perform certain functions by coordinated operation of the implantable CRM device and another one or more implantable devices. Such coordinated operation enables the CRM system to perform, for example, monitoring and/or therapeutic functions at multiple locations in a body that are practically difficult to access by using a single implantable device. For this and other reasons, there is a need for an intra-body communication link between two implantable medical devices.

SUMMARY

An implantable medical device includes an acoustic transducer for intra-body communication with another medical device via an acoustic couple. The acoustic transducer includes one or more piezoelectric transducers physically fastened to the housing of the implantable medical device, directly or via a supporting structure.

In one embodiment, an implantable medical device includes a CRM device, an acoustic communication circuit, an acoustic transducer, and an implantable housing. The acoustic communication circuit is coupled to the CRM device and includes at least one of a data transmitter and a data receiver. The acoustic transducer is coupled to the acoustic communication circuit and functions as an acoustic coupler for acoustic communication. The implantable housing includes a wall forming a chamber to contain the CRM device and the acoustic communication circuit.

In one embodiment, an implantable medical device includes a sensing and/or therapy delivery circuit, a plurality of acoustic transducers, an acoustic communication circuit, and an implantable housing. The acoustic transducers function as an acoustic coupler for acoustic communication. The acoustic communication circuit is coupled to the sensing and/or therapy delivery circuit and includes a transducer interface circuit coupled to the acoustic transducers. The implantable housing includes a wall forming a chamber to contain the sensing and/or therapy delivery circuit and the acoustic communication circuit.

In one embodiment, a CRM system includes two or more medical devices. One medical device is an implantable medical device including a CRM device, an acoustic communication circuit coupled to the CRM device, and an acoustic transducer coupled to the acoustic communication circuit. The acoustic transducer functions as an acoustic coupler for an acoustic couple. Another medical device communicates with the implantable medical device via the acoustic couple.

In one embodiment, an implantable medical device includes an acoustic communication circuit, an acoustic transducer, and an implantable housing. The acoustic transducer is coupled to the acoustic communication circuit and functions as an acoustic coupler for acoustic communication. The implantable housing includes a wall forming a chamber to contain at least the acoustic communication circuit. The acoustic transducer is fastened to the wall of the implantable housing. In an alternative embodiment, a diaphragm is connected to the wall of the implantable housing. The acoustic transducer is fastened to the diaphragm.

A method for making an implantable medical device with acoustic communication is provided. In one embodiment, a CRM device with a communication circuit is provided. An implantable housing including a wall forming a chamber is provided. An acoustic transducer is connected to the communication circuit to function as an acoustic coupler. An acoustic coupler assembly including the acoustic transducer is connected to the wall. The CRM device and the communications circuit are encapsulated in the chamber of the implantable medical device.

This Summary is an overview of some of the teachings of the present application and not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details about the present subject matter are found in the detailed description and appended claims. Other aspects of the invention will be apparent to persons skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part thereof, each of which are not to be taken in a limiting sense. The scope of the present invention is defined by the appended claims and their equivalents.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numerals describe similar components throughout the several views. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.

FIG. 1 is an illustration of an embodiment of portions of a CRM system and portions of an environment in which it is used.

FIG. 2 is block diagram illustrating one embodiment of a circuit of an implantable medical device with an acoustic transducer as an acoustic coupler for the acoustic communication.

FIG. 3A is a side view, and FIG. 3B is a corresponding cross-sectional view, illustrating one embodiment of the implantable medical device with the acoustic transducer.

FIG. 4 is a cross-sectional view illustrating one embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 5 is a cross-sectional view illustrating another embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 6 is a cross-sectional view illustrating another embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 7 is a cross-sectional view illustrating another embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 8 is a cross-sectional view illustrating another embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 9 is a cross-sectional view illustrating another embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 10 is a cross-sectional view illustrating another embodiment of the acoustic transducer fastened to a portion of the implantable medical device.

FIG. 11 is a cross-sectional view illustrating one embodiment of multiple acoustic transducers fastened to a portion of the implantable medical device.

FIG. 12A is a side view, and FIG. 12B is a corresponding cross-sectional view, illustrating one embodiment of an acoustic transducer array fastened to a portion of the implantable medical device.

FIG. 13 is a cross-sectional view illustrating one embodiment of an implantable medical device with two acoustic transducers for acoustic communication.

FIG. 14 is a block diagram illustrating one embodiment of an acoustic communication circuit of the implantable medical device.

FIG. 15 is a schematic/block diagram illustrating details of the acoustic communication circuit of FIG. 14.

FIG. 16 is a schematic/block diagram illustrating another embodiment of the acoustic communication circuit.

FIG. 17 is a diagram illustrating a need for frequency diversity.

FIG. 18 is a flow chart illustrating an embodiment of a method for making an implantable medical device with an acoustic transducer for acoustic communication.

DETAILED DESCRIPTION

In the following detailed description, reference is made to the accompanying drawings which form a part hereof, and in which is shown by way of illustration specific embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that the embodiments may be combined, or that other embodiments may be utilized and that structural, logical and electrical changes may be made without departing from the spirit and scope of the present invention. The following detailed description provides examples, and the scope of the present invention is defined by the appended claims and their equivalents.

It should be noted that references to “an”, “one”, or “various” embodiments in this document are not necessarily to the same embodiment, and such references contemplate more than one embodiment.

This document discusses, among other things, an implantable medical device including an acoustic communication circuit for intra-body acoustic communication. The intra-body acoustic communication is performed between two implantable medical devices or between one implantable medical device and one external medical device attached onto the skin. The implantable medical device of the present subject matter is described in this document by using an implantable CRM device as a specific example. However, it is to be understood that the present methods and apparatuses may be employed in other types of implantable medical devices, including, but not being limited to, neural stimulators, neuromuscular stimulators, drug delivery devices, and various types of other therapeutic and monitoring devices.

FIG. 1 is a block diagram illustrating an embodiment of a CRM system 100, and portions of an environment in which system 100 is used. System 100 includes an implantable medical device 110, a lead system 108, another implantable medical device 120, and an external system 190. An acoustic couple 115 provides for communication between implantable medical device 110 and implantable medical device 120. A wireless telemetry link 180 provides for communication between implantable medical device 110 and external system 190.

After implantation, implantable medical device 110 operates within a body 102 of a patient to sense activities of a heart 105 and deliver one or more therapies to heart 105 through lead system 108. In one embodiment, as illustrated in FIG. 1, implantable medical device 110 is an implantable CRM device that delivers one or more therapies including, but are not limited to, a pacing therapy, a cardioversion/defibrillation therapy, a cardiac resynchronization therapy (CRT), a remodeling control therapy (RCT), a drug therapy, and a biological therapy such as a cell therapy and a gene therapy. Implantable medical device 120 also operates within body 102 to perform one or more sensing and/or therapeutic functions. In one embodiment, implantable medical device 120 supports or supplements one or more functions of implantable medical device 110. Acoustic couple 115 allows implantable medical device 110 and implantable medical device 120 to communicate with each other when a wired connection between the two implantable medical devices is difficult to implement because of, for example, anatomical structure of body 102.

Lead system 108 provides one or more electrical connections between implantable medical device 110 and heart 105. In one embodiment, lead system 108 includes one ore more leads each including one or more electrodes configured for endocardial and/or epicardial placement. Pacing and/or cardioversion/defibrillation are delivered to heart 105 through such leads and electrodes. In one embodiment, one or more leads of lead system 108 also include therapy delivery ports configured for endocardial, epicardial, and/or intravascular placement. Substances such as chemical or biological agents are delivered to heart 105 through such leads and therapy delivery ports.

In one embodiment, implantable medical device 120 includes an implantable sensing module. In one specific embodiment, the implantable sensing module is a pressure sensing module implanted in the left ventricle (LV) to sense an LV pressure that is used by implantable medical device 110 as a signal controlling its therapy delivery function. The use of such an implantable sensing module allows LV pressure sensing while avoiding the difficulty associated with accessing the LV using an implantable pressure catheter connected to implantable medical device 110. In other specific embodiments, the implantable sensing module is used to sense a pulmonary pressure or an aortic pressure while avoiding the use of an implantable pressure catheter that has to pass two cardiac valves to connect to implantable medical device 110. Acoustic couple 115 provides for communications between implantable medical device 110 and implantable medical device 120. In one embodiment, where implantable medical device 120 is a pressure sensing module employed for sensing an intracardiac or intravascular pressure, implantable medical device 110 sends a command via acoustic couple 115 to activate implantable medical device 120 when the pressure sensing is needed. In response, implantable medical device 120 is activated and sends data representative of the sensed pressure to implantable medical device 110 via acoustic couple 115.

Acoustic couple 115 is a data communication link formed between two acoustic couplers. When being used for intra-body communications, acoustic communication is substantially more energy-efficient when compared to telemetry communication based on inductive couple (magnetic field) or radio-frequency electromagnetic waves. Implantable medical device 110 and implantable medical device 120 each include an acoustic coupler, which includes an acoustic transducer. The acoustic transducer converts electrical energy to acoustic energy for transmitting a signal and converts acoustic energy to electrical energy for receiving a signal. The acoustic signals usable for intra-body communication purposes include audible and ultrasonic signals. The carrier frequency for the acoustic signals can be up to 5 MHz. In one embodiment, the carrier frequency range is generally within an ultrasonic range. The lower bound of the carrier frequency range is chosen based on considerations of patient's audio perception of the acoustic signal and the design constraints of the acoustic transducer, and the upper bound of the frequency range is chosen based on considerations of tissue absorption of the acoustic energy and the directionality of the acoustic transducer in transmitting and receiving audio signals. The carrier frequency is chosen to avoid using an acoustic signal audible to the patient. Structural constraints, such as size and material, that generally apply to implantable medical device 110 also affect the selection of the carrier frequency. For example, size of the transducer, stiffness of the support structure to which the transducer is attached, and whether the transducer is to operate in resonance are among the factors to be considered in selecting the carrier frequency. Such factors are dependent on the overall size, material, and structure of implantable medical device 110. In one specific embodiment, the lower bound of the carrier frequency is about 30 kHz. The tissue absorption of acoustic energy generally increases with the frequency of the acoustic signal, making acoustic communication less energy-efficient at higher frequencies. The degree of directionality also generally increases with the frequency of the acoustic signal, making an acoustic coupler more directional (i.e., covering a smaller space) at higher frequencies. In one embodiment, the upper bound of the frequency range is about 60 kHz, where the tissue absorption is not considered significant and an approximately omni-directional acoustic coupler can be implemented. An omni-directional acoustic coupler is desirable because the acoustic communication is not affected by the relative positions of the implantable medical device 110 and implantable medical device 120, which change as the patient makes a movement.

External system 190 communicates with implantable medical device 110 via telemetry link 180. External system 190 allows a physician or other caregiver to communicate with implantable medical device 110. In one embodiment, external system 190 includes an external programmer. In another embodiment, external system 190 includes a patient management system including an external device communicating with implantable medical device 110 via telemetry link 180, a network coupled to the external device, and a remote device coupled to the network. Such a patient management system allows a physician or other caregiver to communicate with implantable medical device 110 through the remote device in a distant location. In one embodiment, the physician or other caregiver also communicates with implantable medical device 120.

Telemetry link 180 provides for data transmissions between implantable medical device 110 and external system 190. In one embodiment, telemetry link 180 also provides for data transmissions between implantable medical device 120 and external system 190. In another embodiment, implantable medical device 120 and external system 190 communicate via acoustic couple 115 and telemetry link 180, using implantable medical device 110 as a repeater. In one embodiment, telemetry link 180 is an inductive telemetry link. In an alternative embodiment, telemetry link 180 is a far-field radio-frequency telemetry link. In another alternative embodiment, telemetry link 180 is another acoustic couple. An acoustic coupler device of external system 190 includes an acoustic transducer that is to be attached to the skin of the patient such that intra-body acoustic communication can be performed using body 102 as the medium. Data transmission provided by telemetry link 180 may include, for example, transmitting real-time physiological data acquired by implantable medical devices 110 and/or 120, extracting physiological data acquired by and stored in implantable medical devices 110 and/or 120, extracting therapy history data stored in implantable medical devices 110 and/or 120, and extracting data indicating an operational status of implantable medical devices 110 and/or 120 (e.g., battery status and lead impedance). Telemetry link 180 also provides for data transmission from external system 190 to implantable medical devices 110 and/or 120. This may include, for example, programming implantable medical devices 110 and/or 120 to acquire physiological data, programming implantable medical devices 110 and/or 120 to perform at least one self-diagnostic test (such as for a battery status and lead impedance status), and programming implantable medical devices 110 and/or 120 to deliver at least one therapy. Examples of signals represented by the physiological data include, but are not limited to, electrograms, heart sounds or signals indicative of heart sounds, activity level signals, pressure signals, impedance signals, and respiratory signals. In one embodiment, the physiological data also include parameters measured from one or more of these signals. In one embodiment, external system 190 or the physician or other caregiver determines and/or adjusts a therapy based on these signals and/or physiological data.

FIG. 2 is block diagram illustrating one embodiment of a circuit of implantable medical device 110. Implantable medical device 110 includes a CRM device 225, an acoustic communication circuit 230, and an acoustic transducer 232. CRM device 225 includes one or more of a sensing circuit to sense one or more physiologic signals and a therapy delivery circuit. CRM device 225 includes, but is not limited to, one or more of a monitoring device sensing one or more physiologic signals, a pacing device, a cardioversion/defibrillation device, a CRT device, an RCT device, a drug delivery device, a cell therapy device, a gene therapy device, and a therapy delivery controller device. Acoustic communication circuit 230 is connected to acoustic transducer 232, which is used as the acoustic coupler for the acoustic communication. CRM device 225 and acoustic circuit 230, or portions of each, are encapsulated by an implantable housing 212 to form implantable medical device 110.

Acoustic transducer 232 includes one or more piezoelectric transducers. The piezoelectric transducer is made of a piezoelectric material such as polyvinylidene fluoride (PVDF) or piezoelectric ceramic. In one embodiment, acoustic transducer 232 includes a single piezoelectric transducer. In another embodiment, acoustic transducer 232 is an acoustic transducer array including a plurality of acoustic transducers each being a piezoelectric transducer. In one specific embodiment, acoustic transducer 232 includes a microelectromechanical acoustic transducer array (MEMS-UTA). In one embodiment, a piezoelectric transducer functions as an approximately omni-directional acoustic coupler for the acoustic communication. In another embodiment, a piezoelectric transducer functions as a directional acoustic coupler having a directionality of greater than 180 degrees to cover more than a hemispherical space. In another embodiment, a piezoelectric transducer functions as a directional acoustic coupler having a directionality of less than 180 degrees. In one embodiment, an acoustic transducer array including a plurality of piezoelectric transducers each having a limited directionality. A transducer interface circuit is connected to the acoustic transducer array to make it an electronically steerable acoustic coupler.

In general, acoustic communication circuit 230 and acoustic transducer 232, including their various embodiments, provide acoustic communication to an implantable medical device used in CRM or other applications. In non-CRM embodiments, CRM device 225 is replaced by a non-CRM device that includes at least one of a monitoring device to sense one or more physiologic signals and a therapy delivery device. In one embodiment, an implantable medical device includes a monitoring device coupled to acoustic communication circuit 230 and acoustic transducer 232. The monitoring device includes one or more sensors to sense one or more physiologic signals. In another embodiment, an implantable medical device includes an electrical stimulation device coupled to acoustic communication circuit 230 and acoustic transducer 232. Examples of the electrical stimulation device include a neural stimulation device and a neuromuscular stimulation device. In another embodiment, an implantable medical device includes a drug delivery device coupled to acoustic communication circuit 230 and acoustic transducer 232. The drug delivery device delivers one or more of chemical, biochemical, and biological agents intended for use in the diagnosis, cure, mitigation, treatment, or prevention of one or more diseases.

FIG. 3A is a side view, and FIG. 3B is a corresponding cross-sectional view, illustrating one embodiment of implantable medical device 110 with acoustic transducer 232 as the acoustic coupler for the acoustic communication. Implantable medical device 110 includes implantable housing 212, which is hermetically sealed and contains electronic circuitry and other structural components. Implantable housing 212 includes a wall 342 forming a chamber 340 that contains CRM device 225 and acoustic communication circuit 230 or portions of each. Wall 342 has an exterior surface 343 and an interior surface 344. Interior surface 344 is the surface facing chamber 340 (i.e., on the side of chamber 340). Acoustic transducer 232 is fastened to wall 343 and connected to acoustic communication circuit 230 through an interconnection cable 334. The thickness of a piezoelectric transducer is on the order of 0.1 mm and is typically less than 0.5 mm, making acoustic transducer 232 physically suitable for inclusion in implantable medical device 110 and attachment to wall 343. In one embodiment, interconnection cable 334 is a strip cable. In another embodiment, interconnection cable 334 is a spring cable. A header 314 is attached to implantable housing 212. Header 314 includes connectors 315 that provide for an interface between implantable medical device 110 and lead system 108. The size and shape of each component, as well as the number of connector 315 and the number of interconnection cable 334, as shown in FIGS. 3A and 3B are for illustrative purpose only and not for any restrictive purpose.

In one embodiment, implantable housing 212 is a can made of a biocompatible metallic material such as titanium. Acoustic transducer 232 is fastened to wall 342 using any method that provides a permanent attachment of the transducer to the wall. In one embodiment, acoustic transducer 232 is glued to wall 342 using a medical grade adhesive such as medical grade epoxy. In another embodiment, acoustic transducer 232 is spot-welded to wall 342. In another embodiment, acoustic transducer 232 is soldered to wall 342. In another embodiment, acoustic transducer 232 is braced to wall 342. Specific examples of acoustic transducer 232 fastened to a portion of implantable medical device 110 are discussed below with reference to FIGS. 4-12.

FIG. 4 is a cross-sectional view illustrating one embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, acoustic transducer 232 is fastened to interior surface 344 of wall 342. Thus, acoustic transducer 232 is within chamber 340, inside the hermetically sealed implantable housing 212.

FIG. 5 is a cross-sectional view illustrating another embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, acoustic transducer 232 is fastened to exterior surface 343 of wall 342. Acoustic transducer 232 is made biocompatible. In one embodiment, acoustic transducer 232 includes one or more transducers made of a biocompatible piezoelectric material. In another embodiment, acoustic transducer 232 includes one or more transducers coated with a biocompatible material.

FIG. 6 is a cross-sectional view illustrating another embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, a diaphragm 645 is connected to exterior surface 343 of wall 342 to form an isolated cavity 647 between diaphragm 645 and exterior surface 343. Acoustic transducer 232 is fastened to diaphragm 645 and is within cavity 647. Diaphragm 645 is sufficiently thin to be acoustically transparent, i.e., to have minimal acoustic absorption, and protects acoustic transducer 232, such as from effects of tissue growth. In one embodiment, diaphragm 645 and implantable housing 212 are made of the same type biocompatible metal, such as titanium. In another embodiment, diaphragm 645 and implantable housing 212 are made of different type biocompatible metals. In one embodiment, diaphragm 645 is welded to exterior surface 343. Acoustic transducer 232 is connected to acoustic communication circuit 230 via one or more hermetically sealed feedthroughs across wall 342. Damage to diaphragm 645 does not destroy the hermetical sealing of implantable housing 212.

In one embodiment, diaphragm 645 is configured to have a resonant frequency approximately equal to the carrier frequency of the acoustic signal. This increases the efficiency of the acoustic transmission. Resonance occurs at a primary frequency and its harmonic frequencies, thus providing a number of frequencies that can be used as the carrier frequency of the acoustic communication when maximum efficiency is sought. In one embodiment, diaphragm 645 is substantially thinner than wall 342 to provide a resonance frequency in the carrier frequency range for the acoustic communication, e.g., about 30 kHz-60 kHz. When acoustic transducer 232 is fastened to a thicker diaphragm 645 or wall 342, the efficiency for the acoustic communication is lower.

FIG. 7 is a cross-sectional view illustrating another embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, diaphragm 645 is connected to exterior surface 343 of wall 342 to form isolated cavity 647 between diaphragm 645 and exterior surface 343. Acoustic transducer 232 is fastened to exterior surface 343 of wall 342 and is within cavity 647. This embodiment differs from the embodiment illustrated in FIG. 6 in that acoustic transducer 232 is fastened to exterior surface 343 of wall 342 instead of diaphragm 645. Hermetically sealed cavity 647 is filled with fluid, such as gel. The fluid functions as medium for the acoustic communication between diaphragm 645 and acoustic transducer 232.

FIG. 8 is a cross-sectional view illustrating another embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, a wall 842 represents an alternative embodiment of wall 342 of implantable housing 212. Wall 842 includes an exterior surface 843 corresponding to exterior surface 343 and an interior surface 844 corresponding to interior surface 344. Wall 842 includes a thinned portion forming a diaphragm 845. Acoustic transducer 232 is fastened to diaphragm 845 on the side of interior surface 844, within the chamber formed by wall 843. By resonance, diaphragm 845 provides a higher efficiency for the acoustic communication when compared to other portions of wall 842 (or wall 342).

FIG. 9 is a cross-sectional view illustrating another embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, a wall 942 represents an alternative embodiment of wall 342 of implantable housing 212. Wall 942 includes an exterior surface 943 corresponding to exterior surface 343 and an interior surface 944 corresponding to interior surface 344. Wall 942 includes a hole 948. A diaphragm 945 is connected to wall 942 over the hole. Acoustic 232 is fastened to diaphragm 945 on the side of interior surface 944, within the chamber formed with wall 942. In one embodiment, diaphragm 945 is welded to wall 942. The connection between diaphragm 945 and wall 942 is hermetically sealed. By resonance, diaphragm 945 provides a higher efficiency for the acoustic communication when compared to other portions of wall 942 (or wall 342).

FIG. 10 is a cross-sectional view illustrating another embodiment of acoustic transducer 232 fastened to a portion of implantable medical device 110. In this embodiment, a wall 1050 represents a sheet structure being a portion of implantable medical device 110, such as a wall (342, 842, or 942) or a diaphragm (645, 845, or 945). A coating 1049 with a predetermined stiffness is applied to a portion of wall 1050, on either of its surfaces, and acoustic transducer 232 is fastened to wall 1050 over coating 1049. Coating 1049 provides a desirable resonant frequency that is difficult to provide with wall 1050 alone. The resonant frequency depends on the thickness of wall 1050, the thickness of coating 1049, and the properties of each of wall 1050 and coating 1049 including stiffness.

FIG. 11 is a cross-sectional view illustrating one embodiment of an acoustic transducer 1132 to a portion of implantable medical device 110. Acoustic transducer 1132 represents one specific embodiment of acoustic transducer 232 and includes stacked acoustic transducers 1132A-E each being a piezoelectric transducer. The number of the transducers included in acoustic transducer 1132 as shown in FIG. 11 is for illustrative purpose only and not for any restrictive purpose. In one embodiment, the total height of the stacked acoustic transducers 1132A-E is limited to about 1.0 mm or any other height suitable for inclusion in implantable medical device 110. A wall 1150 represents a sheet structure being a portion of implantable medical device 110, such as a wall (342, 842, or 942) or a diaphragm (645, 845, or 945). Stacked acoustic transducers 1132A-E are fastened to either surface (side) of wall 1150. In one embodiment, acoustic transducers 1132A-E are connected in series and then connected to acoustic communication circuit 230. In another embodiment, acoustic transducers 1132A-E are connected in parallel and then connected to acoustic communication circuit 230. In another embodiment, a programmable interconnection network provides the interconnections among acoustic transducers 1132A-E. Such interconnections are made in accordance with impedance matching requirements, signal amplitude requirements, and signal-to-noise ratio requirements, which are dependent on the physical dimensions of each acoustic transducer. In one embodiment, acoustic transducers 1132A-E are connected in series when acoustic communication circuit 230 receives an incoming acoustic signal and in parallel when acoustic communication circuit 230 transmits an outgoing acoustic signal.

FIG. 12A is a side view, and FIG. 12B is a corresponding cross-sectional view, illustrating one embodiment of an acoustic transducer 1232 fastened to a portion of implantable medical device 110. Acoustic transducer 1232 represents one specific embodiment of acoustic transducer 232 and includes an array of acoustic transducers each being a piezoelectric transducer. In one embodiment, acoustic transducer 1232 is an MEMS-UTA. The number and layout of the transducers in acoustic transducer 1232 as shown in FIG. 12 are for illustrative purpose only and not for any restrictive purpose. A wall 1250 represents a sheet structure being a portion of implantable medical device 110, such as a wall (342, 842, or 942) or a diaphragm (645, 845, or 945). Acoustic transducer 1232 is fastened to either surface (side) of wall 1250. In one embodiment, a transducer interface circuit provides programmable tuning for each transducer of the array of acoustic transducers. In one embodiment, the array of acoustic transducers form an acoustic coupler having a directionality and effective orientation each electronically controllable through the transducer interface circuit. In one specific embodiment, the transducer interface circuit drives each transducer of the array of acoustic transducers with a programmable phase delay. The directionality and effective orientation of the acoustic coupler is controlled by programming the phase delays.

FIG. 13 is a cross-sectional view illustrating one embodiment of implantable medical device 110 with two acoustic transducers for the acoustic communication. In this embodiment, implantable medical device 110 includes acoustic transducer 232 and a second acoustic transducer 1332. Acoustic transducers 232 and 1332 each have a directionality of approximately 180 degrees or a directionality of greater than 180 degrees but substantially smaller than 360 degrees. Being fastened to opposite sides of implantable housing 212 and facing opposite directions, acoustic transducers 232 and 1332 form an acoustic coupler system that is substantially omni-directional.

FIG. 14 is a block diagram illustrating one embodiment of an acoustic communication circuit 1430, which represents one embodiment of acoustic communication circuit 230. A control circuit in CRM device 225 controls the operation of acoustic communication circuit 1430, including enablement of one of receiving data and transmitting data. An acoustic transducer 1432 represents one specific embodiment of acoustic transducer 232, or generally, an acoustic coupler including one or more acoustic transducers. A transmitter 1460 and a receiver 1470 are connected to acoustic transducer 1432. After being enabled by a transmission enable signal generated by the control circuit in CRM device 225, transmitter 1460 produces an outgoing acoustic signal modulated by outgoing data from CRM device 225. After being enabled by a receiving enable signal generated by the control circuit in CRM device 225, receiver 1470 receives an incoming acoustic signal modulated by incoming data from another device such as implantable medical device 120. Transmitter 1460 and receiver 1470 are enabled one at a time such that acoustic transducer 1432 are used for both transmitting and receiving acoustic signals.

In one embodiment, the outgoing data and the incoming data are both binary data. The outgoing acoustic signal and the incoming acoustic signal each include a carrier signal modulated by data using one of amplitude-shift keying (ASK), frequency-shift keying (FSK), and phase-shift keying (PSK). In one embodiment, to keep acoustic communication circuit 1430 simple, ASK is chosen as the modulation scheme. In one specific embodiment, on-off keying (OOK), or ASK with near 100% modulation index, is chosen as the modulation scheme.

FIG. 15 is a schematic/block diagram illustrating additional details of transmitter 1460 and receiver 1470 of acoustic communication circuit 1430. Transmitter 1460 includes a carrier generator 1562, an ASK modulator 1564, and buffers 1566A and 1566B. Carrier generator 1562 generates the carrier signal for the acoustic communication. In one embodiment, the carrier signal is a square wave. In one embodiment, the frequency of the carrier signal is within a range of about 30 kHz-60 kHz. ASK modulator 1564 modulates the carrier signal received from carrier generator 1562 with the outgoing data received from CRM device 225. The resultant outgoing acoustic signal is applied to acoustic transducer 1432 through buffers 1566A and 1566B when these buffers are enabled for passing signals by the transmission enable signal. Receiver 1470 includes a buffer or amplifier 1572 and an ASK demodulator 1574. ASK demodulator 1574 receives an incoming signal from acoustic transducer 1432 through buffer or amplifier 1572 when the buffer or amplifier is enabled for passing signal by the receiving enable signal. ASK demodulator 1574 demodulates the incoming signal to recover the incoming data. The incoming data are then sent to CRM device 225.

FIG. 16 is a schematic/block diagram illustrating an acoustic communication circuit 1630, which represents another embodiment of acoustic communication circuit 230. Acoustic communication circuit 1630 is connected to an acoustic transducer 1632 and includes a transducer interface circuit 1635, a data transmitter 1660, a data receiver 1670, a power receiver 1675, and a frequency selection circuit 1678. In various embodiments, acoustic communication circuit 230 includes components including, but not being limited to, some or all components of acoustic communication circuit 1630 as illustrated in FIG. 16.

Acoustic transducer 1632 represents one specific embodiment of acoustic transducer 232 or generally, an acoustic coupler including one or more acoustic transducers. In one embodiment, transducer interface circuit 1635 includes a tuning circuit. The tuning circuit provides a desirable quality factor (Q) for the acoustic coupler. In another embodiment, transducer interface circuit 1635 includes impedance matching circuitry for impedance matching between acoustic transducer 1635 and acoustic communication circuit 1630. In another embodiment, in which acoustic transducer 1632 includes stacked multiple acoustic transducers, such as stacked multiple acoustic transducers 1132A-E, transducer interface circuit 1635 includes the programmable interconnections network to control an impedance of acoustic transducer 1632. In another embodiment, in which acoustic transducer 1632 includes an acoustic transducer array such as acoustic transducer 1232, transducer interface circuit 1635 includes a steering circuit to electronically control the directionality and effective orientation of acoustic transducer 1632 as the acoustic coupler. In one specific embodiment, the steering circuit controls the directionality and effective orientation of acoustic transducer 1632 by applying an individually programmed phase delay to each transducer of the acoustic transducer array.

Data transmitter 1660 includes a carrier generator 1662, a modulator 1664, and a buffer 1666. Carrier generator 1662 generates the carrier signal for the acoustic communication. In one embodiment, the carrier signal is a square wave. In one embodiment, the frequency of the carrier signal is within a range of about 30 kHz-60 kHz. Modulator 1664 modulates the carrier signal received from carrier generator 1662 with the outgoing data received from CRM device 225. The resultant outgoing acoustic signal is applied to acoustic transducer 1632 through buffer 1666 when the buffer is enabled for passing signals by the transmission enable signal received from CRM device 225. Data receiver 1670 includes a buffer or amplifier 1672, a demodulator 1674, and an error detector 1676. Demodulator 1674 receives an incoming signal from acoustic transducer 1632 through buffer or amplifier 1672 when the buffer is enabled for passing signal by the receiving enable signal received from CRM device 225. Demodulator 1674 demodulates the incoming signal to receive the incoming data. Error detector 1676 detects errors from the incoming data to determine an error rate. The incoming data are sent to CRM device 225 if the error rate is below a predetermined threshold rate.

Power receiver 1675 receives the acoustic signal from acoustic transducer 1632 through buffer or amplifier 1672 when the buffer is enabled and recovers direct current (dc) energy from the incoming acoustic signal. An external device including an acoustic transducer is used to transmit energy to implantable medical device 110 through acoustic transducer 1632. In one embodiment, power receiver 1675 includes a rectifier circuit and a low-pass filter to convert the acoustic signal to a dc voltage, which is then used to recharge a rechargeable battery being a power supply of implantable medical device 110. Though it may take several days to fully recharge a substantially depleted rechargeable battery, this method can be applied to partially recharge a rechargeable battery, for example, whenever the external device is coupled to implantable medical device 110.

In one embodiment, acoustic couple 115 employs frequency diversity for a reliable acoustic communication between implantable medical device 110 and implantable medical device 120. Two or more substantially different frequencies are used as carrier frequencies of the acoustic signal. FIG. 17 is a diagram illustrating the need for frequency diversity. An acoustic signal is transmitted from implantable medical device 110 to be received by implantable medical device 120. The acoustic wave propagated from implantable medical device 110 is reflected at boundaries of different anatomical structures within body 102. As illustrated in FIG. 17, the acoustic wave is reflected at a reflector 1792, which is an anatomic structure such as a bone. Solid lines 1794 represent equipotential surfaces of the incident acoustic wave propagated from the acoustic transducer of implantable medical device 110. Solid lines 1795 represent equipotential surfaces of the reflected acoustic wave due to reflector 1792. The positions of solid lines 1794 and solid line 1795 are a function of the carrier frequency of the acoustic signal. One effect of the reflection of the acoustic wave caused by reflector 1792 is “nulls” distributed in body 102. The nulls are illustrated as solid dots 1796. Each null represents a point where the incident acoustic wave and the reflected acoustic wave cancel out. If the acoustic transducer of implantable medical device 120 happens to coincide with one of the nulls, it does not receive the acoustic signal. Due to the body anatomy and movements of the patient, numerous reflectors exist in body 102 and their location relative to implantable medical devices 110 and 120 change from time to time. The relative locations of implantable medical devices 110 and 120 also change for the same reason. It is therefore infeasible to avoid the nulls by choosing implantation sites for implantable medical devices 110 and 120.

One approach to ensure substantially uninterrupted reception of the acoustic signal is frequency diversity. If the acoustic signal at a first carrier frequency is not receivable due to a null, a substantially different second carrier frequency is used. In FIG. 17, solid lines 1794 represent equipotential lines of the incident wave, and solid lines 1795 represent equipotential lines of the reflected wave, at the first carrier frequency. Dashed lines 1797 represent equipotential lines of the incident wave, and dashed lines 1798 represent equipotential lines of the reflected wave, at the second carrier frequency. Solid dots 1796 represent the nulls at the first frequency. Hollow dots 1799 represent the nulls at the second frequency. The acoustic signal is received by implantable medical device 120 when the acoustic transducer does not coincide with nulls at both frequencies, i.e., does not coincide with both one of solid dots 1796 and one of hollow dots 1799. Three or more carrier frequencies may be used for the frequency diversity to further ensure reliability of the acoustic communication. In one embodiment, two carrier frequencies are considered sufficient because the chance that the nulls at two substantially different frequencies coincide is considered as being sufficiently small.

In one embodiment, when the error rate of the incoming date exceeds the predetermined threshold rate, as determined by error detector 1676, frequency selection circuit 1678 selects a substantially different frequency to be the carrier frequency for the acoustic communication. For example, acoustic communication circuit 1630 uses first and second carrier frequencies for the acoustic communication via acoustic couple 115. When acoustic couple 115 is established or activated, frequency selection circuit 1678 selects the first carrier frequency. When error detector 1676 detects an intolerable error rate, frequency selection circuit 1678 selects the second carrier frequency to replace the first carrier frequency. When error detector 1676 detects another intolerable error rate, with the second carrier frequency, frequency selection circuit 1678 selects the first carrier frequency to replace the second carrier frequency. In this embodiment, carrier generator 1660 includes a variable-frequency carrier generator that generates the carrier signal at the frequency selected by frequency selection circuit 1678. In one specific embodiment, the first carrier frequency is 39 kHz, and the second carrier frequency is 43 kHz. In one embodiment, the acoustic transducer has a low quality factor (Q). Components of acoustic communication circuit 1630, except carrier generator 1662, need no adjustment when the carrier frequency changes from the first carrier frequency to the second carrier frequency. In one embodiment, acoustic communication circuit 1630 has two frequency bands each accommodate one of the carrier frequencies. In another embodiment, acoustic communication circuit 1630 has one wide frequency band that accommodates both carrier frequencies.

In one embodiment, frequency diversity is employed to allow implantable medical device 110 to communicate with two or more other implantable medical devices via separate acoustic couples each using a substantially distinctive carrier frequency. This allows simultaneous communications via multiple acoustic couples.

FIG. 18 is a flow chart illustrating an embodiment of a method for making an implantable medical device with an acoustic transducer for acoustic communication. In one embodiment, the method is applied to make implantable medical device 110 with acoustic transducers 232 including, but not being limited to, all the embodiments discussed in this document.

A CRM device with a communications circuit is provided at 1800. The CRM device includes, but is not limited to, one or more of a monitoring device sensing one or more types of physiologic signals, a pacing device, a cardioversion/defibrillation device, a CRT device, a RCT device, a drug delivery device, a cell therapy device, a gene therapy device, and a therapy delivery controller device.

An implantable housing is provided at 1810. The implantable housing includes a wall forming a chamber. In one embodiment, the implantable housing is made of a biocompatible metal such as titanium.

An acoustic transducer is connected to the communication circuit of the CRM device at 1820. The acoustic transducer functions as an acoustic coupler for the acoustic communication. In one embodiment, a single piezoelectric transducer is connected to the communication circuit. In another embodiment, a piezoelectric transducer array including two or more piezoelectric transducers is connected to the communication circuit. In one embodiment, programmable interconnections are provided for the two or more piezoelectric transducers, such that the interconnections among the piezoelectric transducers can be changed to provide an electronically adjustable overall impedance. In one embodiment, a transducer interface circuit is provided to control a directionality of the acoustic transducer functioning as the acoustic coupler.

An acoustic coupler assembly including the acoustic transducer is connected to the wall of the implantable housing at 1830. In one embodiment, the acoustic coupler assembly includes essentially the acoustic transducer. In another embodiment, the acoustic coupler assembly further includes supporting or other structure such as diaphragm 645 and 945 discussed above. The acoustic coupler assembly is fastened to the wall of the implantable housing. In one embodiment, the acoustic coupler assembly is glued to the wall of the implantable housing. In another embodiment, the acoustic coupler assembly is welded to the wall of the implantable housing. In another embodiment, the acoustic coupler assembly is soldered to the wall of the implantable housing. In another embodiment, the acoustic coupler assembly is braced to the wall of the implantable housing. In another embodiment, a portion of the wall of the implantable housing is thinned, and the acoustic coupler assembly is fastened to the thinned portion of the wall. In one embodiment, the acoustic coupler assembly is fastened to the interior surface of the wall, which is on the side of the chamber formed by the wall. In another embodiment, the acoustic coupler assembly is fastened to the exterior surface of the wall. In one embodiment, the acoustic coupler assembly includes a diaphragm, and the acoustic transducer is fastened to the diaphragm, which is connected to the wall. In one specific embodiment, the diaphragm is connected to the exterior surface of the wall to form an isolated cavity between the diaphragm and the exterior surface, and the acoustic transducer is fastened to the surface of the diaphragm within the cavity. In another specific embodiment, the wall of the implantable housing includes a hole, and the diaphragm is connected to the wall to cover the hole. In one embodiment, the acoustic transducer is an acoustic transducer array including the two or more piezoelectric transducers physically stacked together and fastened to the wall of the implantable housing. In another specific embodiment, the acoustic transducer is an acoustic transducer array including the two or more piezoelectric transducers, with each piezoelectric transducer of the piezoelectric transducer array fastened to the wall.

The CRM device and the communication circuit are encapsulated in the chamber of the implantable housing to form an implantable medical device at 1840. The chamber is hermetically sealed for implantation.

It is to be understood that the above detailed description is intended to be illustrative, and not restrictive. As discussed above, while a CRM system is used as a specific example, the present subject matter generally provides for intra-body communication for any type of implantable medical device. Such implantable medical device includes diagnostic and therapeutic devices such as any patient monitoring devices, neural stimulators, neuromuscular stimulators, and any drug delivery systems. Other embodiments, including any possible permutation of the system components discussed in this document, will be apparent to those of skill in the art upon reading and understanding the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. 

1. An implantable medical device adapted to be communicatively coupled to a second medical device, the implantable medical device comprising: a cardiac rhythm management (CRM) device; an acoustic communication circuit coupled to the CRM device, the acoustic communication circuit including at least one of a data transmitter adapted to transmit an outgoing acoustic signal to the second medical device and a data receiver adapted to receive an incoming acoustic signal from the second medical device; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for acoustic communication including transmitting the outgoing acoustic signal to the second medical device and receiving the incoming acoustic signal from the second medical device; an implantable housing including a wall forming a chamber to contain the CRM device and the acoustic communication circuit; and a diaphragm connected to the wall and configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication, wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein the diaphragm is connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein the acoustic transducer is connected to the diaphragm within the cavity.
 2. The implantable medical device of claim 1, wherein the CRM device comprises one or more of a pacemaker circuit and a cardioversion/defibrillation circuit.
 3. The implantable medical device of claim 1, wherein the CRM device comprises a monitoring device sensing one or more physiologic signals.
 4. The implantable medical device of claim 1, wherein the CRM device comprises a drug delivery device.
 5. The implantable medical device of claim 1, wherein a material having a predetermined stiffness is coated onto the diaphragm.
 6. The implantable medical device of claim 1, wherein the implantable housing and the diaphragm are each made of a metal.
 7. The implantable medical device of claim 6, wherein the implantable housing and the diaphragm are each made of titanium.
 8. The implantable medical device of claim 6, wherein the implantable housing is made of a first type metal, and the diaphragm is made of a second type metal different from the first type metal.
 9. The implantable medical device of claim 1, wherein the acoustic transducer is made of a piezoelectric material.
 10. The implantable medical device of claim 9, wherein the acoustic transducer is made of polyvinylidene fluoride (PVDF).
 11. The implantable medical device of claim 9, wherein the acoustic transducer is made of piezoelectric ceramic.
 12. An implantable medical device adapted to be communicatively coupled to a second medical device, the implantable medical device comprising: one or more of a sensing circuit to sense one or more physiologic signals and a therapy delivery circuit; a plurality of acoustic transducers configured to be an acoustic coupler for acoustic communication including transmitting an outgoing acoustic signal to the second medical device and receiving an incoming acoustic signal from the second medical device; an acoustic communication circuit coupled to the one or more of the sensing circuit and the therapy delivery circuit, the acoustic communication circuit including a transducer interface circuit coupled to the plurality of acoustic transducers, the acoustic communication circuit adapted to transmit the outgoing acoustic signal to the second medical device and receive the incoming acoustic signal from the second medical device using the acoustic coupler; an implantable housing including a wall forming a chamber to contain the one or more of the sensing circuit and the therapy delivery circuit and the acoustic communication circuit; and a metal diaphragm connected to the wall and configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication, wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein the diaphragm is connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein the plurality of acoustic transducers are fastened to the diaphragm within the cavity.
 13. The implantable medical device of claim 12, wherein the plurality of acoustic transducers are configured to be an approximately omni-directional acoustic coupler for the acoustic communication.
 14. The implantable medical device of claim 12, wherein the transducer interface circuit comprises a programmable interconnection network adapted to provide programmable interconnections among acoustic transducers of the plurality of acoustic transducers.
 15. The implantable medical device of claim 14, wherein the acoustic communication circuit comprises a transmitter circuit and a receiver circuit, and wherein the programmable interconnection network is programmed to connect the acoustic transducers in parallel when the transmitter circuit is transmitting a signal and to connect the acoustic transducers in series when the transmitter circuit is receiving a signal.
 16. The implantable medical device of claim 12, wherein the plurality of acoustic transducers comprises a microelectromechanical acoustic transducer array (MEMS-UTA).
 17. The implantable medical device of claim 12, wherein the transducer interface circuit comprises a steering circuit adapted to control a directionality and an effective orientation of the acoustic coupler.
 18. An implantable medical device adapted to be communicatively coupled to a second medical device, the implantable medical device comprising: a cardiac rhythm management (CRM) device; an acoustic transducer configured to be an acoustic coupler for acoustic communication between the implantable medical device and the second medical device; an acoustic communication circuit coupled to the CRM device, the acoustic communication circuit including a data receiver circuit coupled to the acoustic transducer, the data receiver circuit adapted to receive an incoming acoustic signal from the second medical device using the acoustic transducer, the incoming acoustic signal including a first carrier signal modulated by incoming data; and an implantable housing configured to contain the CRM device and the acoustic communication circuit, the implantable housing including a wall forming a chamber to contain the CRM device and the acoustic communication circuit and a diaphragm connected to the wall, the diaphragm thinner than the wall and configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication, wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein the diaphragm is connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein the acoustic transducer is fastened to the diaphragm within the cavity.
 19. The implantable medical device of claim 18, wherein the acoustic communication circuit further comprises a data transmitter circuit, coupled to the acoustic transducer, to transmit an outgoing acoustic signal including a second carrier signal modulated by outgoing data.
 20. The implantable medical device of claim 19, wherein the first carrier signal and the second carrier signal each have a carrier frequency of up to approximately 5 MHz.
 21. The implantable medical device of claim 20, wherein the first carrier signal and the second carrier signal each have a carrier frequency in a range of approximately 30 kHz to 60 kHz.
 22. The implantable medical device of claim 20, wherein the first carrier signal and the second carrier signal each have a carrier frequency in an ultrasonic range.
 23. The implantable medical device of claim 19, wherein the data receiver circuit comprises an amplitude-shift keying (ASK) demodulator, and the data transmitter circuit comprises: an acoustic carrier generator to generate the second carrier signal; and an amplitude-shift keying (ASK) modulator, coupled to the carrier generator and the acoustic transducer, to modulate the second carrier signal with the outgoing data.
 24. The implantable medical device of claim 23, wherein the acoustic carrier generator is a variable-frequency waveform generator programmable for two or more carrier frequencies for the second carrier signal.
 25. The implantable medical device of claim 24, wherein the data receiver circuit comprises an error detector, coupled to the ASK demodulator, to detect an error rate of the demodulated incoming acoustic signal.
 26. The implantable medical device of claim 25, wherein the acoustic communication circuit further comprises a frequency selection circuit to select a carrier frequency from the two or more carrier frequencies for the second carrier signal based on the detected error rate.
 27. The implantable medical device of claim 19, further comprising a rechargeable battery contained in the implantable housing, and wherein the acoustic communication circuit further comprises a power receiver coupled to the acoustic transducer and the rechargeable battery, the power receiver adapted to recover a direct current (dc) power from the acoustic signals to recharge the rechargeable battery.
 28. A cardiac rhythm management (CRM) system, comprising: a first implantable medical device including: a CRM device; an acoustic communication circuit coupled to the CRM device; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for an acoustic couple adapted for data communication; and an implantable housing including a wall and a diaphragm connected to the wall, the wall forming a chamber to contain the CRM device and the acoustic communication circuit, the diaphragm configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication, wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein the diaphragm is connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein the acoustic transducer is connected to the diaphragm within the cavity; and a second medical device communicatively coupled to the first implantable medical device via the acoustic couple, wherein the acoustic communication circuit is adapted to transmit an outgoing acoustic signal to the second medical device and receive an incoming acoustic signal from the second medical device.
 29. The CRM system of claim 28, wherein the CRM device comprises one or more of a pacemaker circuit and a cardioversion/defibrillation circuit.
 30. The CRM system of claim 28, wherein the CRM device comprises a cardiac resynchronization therapy (CRT) device.
 31. The CRM system of claim 28, wherein the CRM device comprises a cardiac remodeling control therapy (RCT) device.
 32. The CRM system of claim 28, wherein the second medical device comprises a second implantable medical device.
 33. The CRM system of claim 32, wherein the second implantable medical device comprises an implantable sensing module adapted to sense at least one physiological signal.
 34. The CRM system of claim 33, wherein the implantable sensing module comprises a pressure sensing module.
 35. The CRM system of claim 28, wherein the second medical device comprises a medical device including at least a portion configured for skin attachment.
 36. The CRM system of claim 35, wherein the second medical device comprises a CRM device programmer adapted to program the first implantable medical device.
 37. An implantable medical device, comprising: at least one of a monitoring device to sense one or more physiologic signals and a therapy delivery device; an acoustic communication circuit coupled to the at least one of the monitoring device and the therapy delivery device; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for acoustic communication; and an implantable housing including a wall forming a chamber to contain the at least one of the monitoring device and the therapy delivery device and the acoustic communication circuit, the wall including an interior surface and an exterior surface, the interior surface facing the chamber; a diaphragm connected to the wall to form a cavity between the diaphragm and the exterior surface of the wall, wherein the acoustic transducer is fastened to the exterior surface of the wall within the cavity, wherein the implantable housing and the diaphragm are made of a first type metal.
 38. The implantable medical device of claim 37, further comprising a monitoring device coupled to the acoustic transducer and contained in the implantable housing, the monitoring device including one or more sensors to sense one or more physiological signals.
 39. The implantable medical device of claim 37, further comprising an electrical stimulation device coupled to the acoustic transducer and contained in the implantable housing.
 40. The implantable medical device of claim 37, further comprising a drug delivery device coupled to the acoustic transducer and contained in the implantable housing.
 41. An implantable medical device adapted to be communicatively coupled to a second medical device, the implantable medical device comprising: at least one of a monitoring device to sense one or more physiologic signals and a therapy delivery device; an acoustic communication circuit coupled to the at least one of the monitoring device and the therapy delivery device, the acoustic communication circuit adapted to transmit an outgoing acoustic signal to the second medical device and receive an incoming acoustic signal from the second medical device; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for acoustic communication including transmitting the outgoing acoustic signal to the second medical device and receiving the incoming acoustic signal from the second medical device; an implantable housing including a wall forming a chamber to contain the at least one of the monitoring device and the therapy delivery device and the acoustic communication circuit; and a diaphragm connected to the wall of the implantable housing and configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication, wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein the diaphragm is connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein the acoustic transducer is fastened to the diaphragm within the cavity.
 42. The implantable medical device of claim 41, further comprising a monitoring device coupled to the acoustic transducer and contained in the implantable housing, the monitoring device including one or more sensors to sense one or more physiological signals.
 43. The implantable medical device of claim 41, further comprising an electrical stimulation device coupled to the acoustic transducer and contained in the implantable housing.
 44. The implantable medical device of claim 41, further comprising a drug delivery device coupled to the acoustic transducer and contained in the implantable housing.
 45. A method for making an implantable medical device, the method comprising: providing an cardiac rhythm management (CRM) device with a communication circuit for acoustic communication between the implantable medical device and a second medical device, the acoustic communication including transmitting an outgoing acoustic signal to the second medical device and receiving an incoming acoustic signal from the second medical device; connecting an acoustic transducer to the communication circuit, the acoustic transducer functioning as an acoustic coupler for the acoustic communication; providing an implantable housing including a wall forming a chamber; providing a diaphragm connected to the wall, the diaphragm configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication; connecting an acoustic coupler assembly including the acoustic transducer to the diaphragm; and encapsulating the CRM device and the communications circuit in the chamber; wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein connecting the diaphragm to the wall further comprises connecting the diaphragm to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein fastening the acoustic transducer to the diaphragm further comprises fastening the acoustic transducer to a surface of the diaphragm within the cavity.
 46. The method of claim 45, wherein connecting the acoustic coupler assembly to the diaphragm comprises fastening the acoustic transducer to the diaphragm.
 47. The method of claim 46, wherein fastening the acoustic transducer to the diaphragm comprises gluing the acoustic transducer to the diaphragm.
 48. The method of claim 46, wherein fastening the acoustic transducer to the diaphragm comprises welding the acoustic transducer to the diaphragm.
 49. The method of claim 46, wherein fastening the acoustic transducer to the diaphragm comprises soldering the acoustic transducer to the diaphragm.
 50. The method of claim 46, wherein fastening the acoustic transducer to the diaphragm comprises bracing the acoustic transducer to the diaphragm.
 51. The method of claim 46, further comprising filling the cavity with fluid.
 52. The method of claim 45, wherein connecting the acoustic transducer to the communication circuit comprises connecting a piezoelectric transducer array to the communication circuit, the piezoelectric transducer array including two or more piezoelectric transducers.
 53. The method of claim 52, wherein connecting the piezoelectric transducer array to the communication circuit comprises stacking the two or more piezoelectric transducers, and wherein connecting the acoustic coupler assembly to the diaphragm comprises fastening the stacked two or more piezoelectric transducers to the diaphragm.
 54. The method of claim 52, wherein connecting the acoustic coupler assembly to the diaphragm comprises fastening each piezoelectric transducer of the two or more piezoelectric transducers to the diaphragm.
 55. The method of claim 52, wherein connecting the acoustic transducer to the communication circuit comprises providing programmable interconnections for the two or more piezoelectric transducers.
 56. The method of claim 55, further comprising providing a transducer interface circuit to control a directionality and an effective orientation of the acoustic transducer functioning as the acoustic coupler.
 57. The method of claim 56, wherein providing the transducer interface circuit comprises providing a programmable phase delay to each piezoelectric transducer of the two or more piezoelectric transducers.
 58. An implantable medical device, comprising: a cardiac rhythm management (CRM) device; an acoustic communication circuit coupled to the CRM device, the acoustic communication circuit including at least one of a data transmitter and a data receiver; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for acoustic communication; and an implantable housing including a wall forming a chamber to contain the CRM device and the acoustic communication circuit, the wall including an interior surface and an exterior surface, the interior surface facing the chamber; and a diaphragm connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, the cavity filled with fluid, wherein the acoustic transducer is fastened to the exterior surface and is within the cavity, and wherein the implantable housing and the diaphragm are both made of titanium.
 59. An implantable medical device, comprising: a cardiac rhythm management (CRM) device; an acoustic communication circuit coupled to the CRM device, the acoustic communication circuit including at least one of a data transmitter and a data receiver; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for acoustic communication; and an implantable housing including a wall forming a chamber to contain the CRM device and the acoustic communication circuit, the wall including an interior surface and an exterior surface, the interior surface facing the chamber; and a diaphragm connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, wherein the acoustic transducer is fastened to the diaphragm and is within the cavity, and wherein the implantable housing and the diaphragm are made of a first type metal.
 60. An implantable medical device, comprising: a cardiac rhythm management (CRM) device; an acoustic communication circuit coupled to the CRM device, the acoustic communication circuit including at least one of a data transmitter and a data receiver; an acoustic transducer coupled to the acoustic communication circuit, the acoustic transducer configured to be an acoustic coupler for acoustic communication; an implantable housing including a wall forming a chamber to contain the CRM device and the acoustic communication circuit; a diaphragm connected to the wall of the implantable housing, the diaphragm configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication; and a material having a predetermined stiffness coated onto the diaphragm to provide the diaphragm with the resonant frequency, wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein the diaphragm is connected to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein the acoustic transducer is fastened to the diaphragm within the cavity.
 61. A cardiac rhythm management (CRM) system, comprising: a CRM device; an acoustic transducer configured to be an acoustic coupler for acoustic communication; an acoustic communication circuit coupled to the CRM device, the acoustic communication circuit including a data receiver circuit and a data transmitter circuit each coupled to the acoustic transducer, the data receiver circuit adapted to receive, using the acoustic transducer, an incoming acoustic signal including a first carrier signal modulated by incoming data, the data transmitter circuit adapted to transmit, using the acoustic transducer, an outgoing acoustic signal including a second carrier signal modulated by outgoing data, the data receiver circuit including: an amplitude-shift keying (ASK) demodulator; and an error detector, coupled to the ASK demodulator, to detect an error rate of the demodulated incoming acoustic signal, the data transmitter circuit including: an acoustic carrier generator to generate the second carrier signal, the acoustic carrier generator being a variable-frequency waveform generator programmable for two or more carrier frequencies for the second carrier signal; and an ASK modulator, coupled to the carrier generator and the acoustic transducer, to modulate the second carrier signal with the outgoing data; and an implantable housing configured to contain the CRM device and the acoustic communication circuit, wherein the acoustic transducer is fastened to the implantable housing, and the acoustic communication circuit further comprises a frequency selection circuit to select a carrier frequency from the two or more carrier frequencies for the second carrier signal based on the detected error rate.
 62. A method for making an implantable medical device, the method comprising: providing a cardiac rhythm management (CRM) device with a communication circuit; providing an implantable housing including a wall forming a chamber, the wall including an interior surface and an exterior surface, the interior surface facing the chamber; connecting an acoustic transducer functioning as an acoustic coupler to the communication circuit; connecting an acoustic coupler assembly including the acoustic transducer to the wall; encapsulating the CRM device and the communications circuit in the chamber; connecting a diaphragm to the exterior surface to form a cavity between the diaphragm and the exterior surface, the diaphragm and the implantable housing both made of titanium; and filling the cavity with fluid, wherein connecting the acoustic coupler assembly to the wall includes fastening the acoustic transducer to the exterior surface within the cavity.
 63. A method for making an implantable medical device, the method comprising: providing a cardiac rhythm management (CRM) device with a communication circuit; providing an implantable housing made of a first type metal and including a wall forming a chamber, the wall including an interior surface and an exterior surface, the interior surface facing the chamber; connecting an acoustic transducer functioning as an acoustic coupler to the communication circuit; coupling an acoustic coupler assembly including the acoustic transducer to the wall; encapsulating the CRM device and the communications circuit in the chamber; and connecting a diaphragm made of the first type metal to the exterior surface to form a cavity between the diaphragm and the exterior surface, wherein coupling the acoustic coupler assembly to the wall includes fastening the acoustic transducer to a surface of the diaphragm within the cavity.
 64. A method for making an implantable medical device, the method comprising: providing a cardiac rhythm management (CRM) device with a communication circuit configured to perform acoustic communication; providing an implantable housing including a wall forming a chamber; connecting an acoustic transducer functioning as an acoustic coupler to the communication circuit, the acoustic transducer including a piezoelectric transducer array including two or more piezoelectric transducers; providing programmable interconnections for the two or more piezoelectric transducers; connecting a metal diaphragm to the wall, the diaphragm configured to have a resonant frequency approximately equal to a carrier frequency used in the acoustic communication; connecting an acoustic coupler assembly including the acoustic transducer to the diaphragm; encapsulating the CRM device and the communications circuit in the chamber; and providing a transducer interface circuit to control a directionality and an effective orientation of the acoustic transducer functioning as the acoustic coupler; wherein the wall of the implantable housing comprises an interior surface and an exterior surface, the interior surface facing the chamber, and wherein connecting the metal diaphragm to the wall further comprises connecting the diaphragm to the exterior surface to form a cavity between the diaphragm and the exterior surface, and wherein fastening the acoustic coupler assembly including the acoustic transducer to the diaphragm further comprises fastening the acoustic transducer to a surface of the diaphragm within the cavity.
 65. The method of claim 64, wherein providing the transducer interface circuit comprises providing a programmable phase delay to each piezoelectric transducer of the two or more piezoelectric transducers. 